Cholecystectomy versus central obesity or insulin resistance in relation to the risk of nonalcoholic fatty liver disease: the third US National Health and Nutrition Examination Survey

Wenzhu Yue, Xingxing Sun, Tingting Du, Wenzhu Yue, Xingxing Sun, Tingting Du

Abstract

Background: Cholecystectomy, central obesity, and insulin resistance (IR) are established risk factors for nonalcoholic fatty liver disease (NAFLD). We aimed to examine the relative contributions and combined association of cholecystectomy and central obesity/IR with NAFLD risk.

Methods: We conducted a cross-sectional analysis of data from the third National Health and Nutrition Examination Survey (NHANES III), in which ultrasonography was performed. Odds ratios (ORs) and 95% confidence intervals for NAFLD were estimated using logistic regression.

Results: Cholecystectomy associated with a higher prevalence of NAFLD compared with gallstones among both centrally obese and non-centrally-obese subjects. Gallstones associated with a higher prevalence of NAFLD only in the presence of central obesity. In centrally obese participants, the OR increased from 2.67 (2.15-3.32) for participants without gallstone disease to 6.73 (4.40-10.29) for participants with cholecystectomy. In participants with cholecystectomy, the OR increased from 2.57 (1.35-4.89) for participants without central obesity to 6.73 (4.40-10.29) for centrally obese counterparts. We observed a modest increase in the risk of NAFLD with cholecystectomy compared with a large increase in the risk with IR or metabolic syndrome.

Conclusion: The magnitude of the NAFLD risk contributed by cholecystectomy was similar to central obesity in combined analyses. The magnitude of the association with IR or metabolic syndrome was greater than with cholecystectomy.

Keywords: Central obesity; Cholecystectomy; Insulin resistance; Nonalcoholic fatty liver disease.

Conflict of interest statement

The authors declare that there is no conflict of interest. None of the authors was employed in Novo Nordisk. The Novo Nordisk company had no role in the design of the study and collection, analysis, and interpretation of data and in the writing the manuscript.

Figures

Fig. 1
Fig. 1
Combined effect of gallstone disease and central obesity on the risk of non-alcoholic fatty liver disease (NAFLD). Age-and sex-standardized prevalence of NAFLD by central obesity and gallstone disease status (a). Combined effect of gallstone disease and central obesity on the odds of NAFLD (b). Cholecystectomy associated with a higher prevalence of NAFLD compared with gallstones among both centrally obese and non-central-obese subjects. Gallstones associated with a higher prevalence of NAFLD only in the presence of central obesity. Odds ratios (95% confidence intervals) of NAFLD for participants categorized by cross-classification of central obesity and gallstone disease status were adjusted for age, sex, race ethnicity, smoking and drinking status, education level, systolic blood pressure, hemoglobin A1c, total cholesterol, and HDL-cholesterol
Fig. 2
Fig. 2
Combined effect of gallstone disease and metabolic syndrome (MetS) or combined effect of gallstone disease and insulin resistance on the risk of non-alcoholic fatty liver disease (NAFLD). Combined effect of gallstone disease and MetS on the odds of NAFLD (a). Combined effect of gallstone disease and insulin resistance on the odds of NAFLD (b). Odds ratios (95% confidence intervals) of NAFLD were adjusted for age, sex, race ethnicity, smoking and drinking status, education level, hemoglobin A1c, and total cholesterol
Fig. 3
Fig. 3
Combined effect of gallstone disease and diabetes on the risk of non-alcoholic fatty liver disease (NAFLD). Odds ratios (95% confidence intervals) of NAFLD were adjusted for age, sex, race ethnicity, smoking and drinking status, education level, total cholesterol, HOMA-IR, waist circumference, hemoglobin A1c, diabetes duration, and anti-diabetic drugs

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